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Pradeau I, Planche L, Dimet J, Winer N, Ducarme G. Dinoprostone vaginal insert compared to cervical ripening balloon as second line of cervical ripening after first dinoprostone insert. Eur J Obstet Gynecol Reprod Biol 2024; 302:87-93. [PMID: 39241285 DOI: 10.1016/j.ejogrb.2024.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 08/05/2024] [Accepted: 08/24/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND AND PROBLEM To compare dinoprostone vaginal insert (PG) with cervical ripening balloon (CRB) as second line of cervical ripening in women at term with a persistent unfavorable cervix after first PG. METHODS This retrospective cohort study comprised all women with singleton fetus in cephalic presentation who required cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using repeated PG or CRB for a persistent unfavorable cervix (Bishop score <6) 24 h after first PG. Primary outcome was vaginal delivery rate. Secondary outcomes were favorable cervix (Bishop score ≥6) or labor within 24 h after second device placement, postpartum hemorrhage (PPH) and neonatal morbidity. FINDINGS 180 women were analyzed (127 repeated PG (70.6 %) and 53 CRB after first PG (29.4 %)). After second device, 93.3 % of women had a favorable cervix (Bishop score ≥6) or were in labor within 24 h, and the rate was significantly higher after CRB, compared to repeated PG (98.1 % vs. 91.3 %; p = 0.048). Vaginal deliveries were similar between groups (62.2 % after repeated PG vs. 54.7 % after CRB; p = 0.36). PPH was observed in 22.2 % of included women, and no difference was observed between groups (21.3 % vs. 21.4 %; p = 0.63). Neonatal morbidity was similar between groups (13.4 % vs. 9.4 %; p = 0.48). CONCLUSION Vaginal delivery rate and neonatal morbidity were similar when using PG or CRB as second line in women at term with a persistent unfavorable cervix after first PG. CRB seemed to be more efficient on the cervix status, compared to repeated PG, in these women.
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Affiliation(s)
- Isabelle Pradeau
- Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France
| | - Lucie Planche
- Clinical Research Centre, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France
| | - Jérome Dimet
- Clinical Research Centre, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France
| | - Norbert Winer
- Department of Obstetrics and Gynaecology, Nantes University Hospital, 44000 Nantes, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynaecology, Centre Hospitalier Departemental, 85000 La Roche sur Yon, France.
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De Berti M, Le Gouge A, Monmousseau F, Gallot D, Sentilhes L, Winer N, Legendre G, Desbriere R, Girault A, Pozzi J, Gachon B, Barjat T, Perrotin F, Brunet-Houdard S, Diguisto C. Oxytocin versus prostaglandins for labour Induction of women with an unfavourable cervix after 24 hours of cervical ripening (OPIC): protocol for an open multicentre randomised non-inferiority trial. BMJ Open 2023; 13:e058282. [PMID: 37068892 PMCID: PMC10111897 DOI: 10.1136/bmjopen-2021-058282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/30/2022] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION It remains uncertain whether the most appropriate management for women with an unfavourable cervix after 24 hours of cervical ripening is repeating the ripening procedure or proceeding directly to induction by oxytocin. No adequately powered trial has compared these strategies. We hypothesise that induction of labour with oxytocin among women who have just undergone an ineffective first ripening procedure is not associated with a higher risk of caesarean delivery than a repeated cervical ripening with prostaglandins. METHODS AND ANALYSIS We will conduct a multicentre, non-inferiority, open-label, randomised controlled trial aimed at comparing labour induction by oxytocin with a second cervical ripening that uses prostaglandins (slow-release vaginal dinoprostone; oral misoprostol 25 µg; dinoprostone vaginal gel 2 mg). Women (n=1494) randomised in a 1:1 ratio in 10 French maternity units must be ≥18 years with a singleton fetus in vertex presentation, at a term from ≥37+0 weeks of gestation, and have just completed a 24-hour cervical ripening procedure by any method (pharmacological or mechanical) with a Bishop score ≤6. Exclusion criteria comprise being in labour, having more than 3 contractions per 10 min, or a prior caesarean delivery or a history of uterine surgery, or a fetus with antenatally suspected severe congenital abnormalities or a non-reassuring fetal heart rate. The primary endpoint will be the caesarean delivery rate, regardless of indication. Secondary outcomes concern delivery, perinatal morbidity, maternal satisfaction and health economic evaluations. The nature of the assessed procedures prevents masking the study investigators and patients to group assignment. ETHICS AND DISSEMINATION All participants will provide written informed consent. The ethics committee 'Comité de Protection des Personnes Ile de France VII' approved this study on 2 April 2021 (No 2021-000989-15). Study findings will be submitted for publication and presented at relevant conferences. TRIAL REGISTRATION NUMBER NCT04949633.
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Affiliation(s)
- Marion De Berti
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Université de Tours, Tours, France
| | | | - Fanny Monmousseau
- Tours University Hospital - Health-Economic Evaluation Unit, CHRU de Tours, Tours Area, France
- University of Tours - EA 7505-Education Ethics Health, Tours Area, France
| | - Denis Gallot
- Service de Gynécologie-Obstétrique, Hôpital d'Estaing, CHU de Clermont-Ferrand, Maternité Clermont Ferrand, France
| | - Loïc Sentilhes
- Service de Gynécologie-Obstétrique, Groupe Hospitalier Pellegrin, CHRU de Bordeaux, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, 44093 Nantes, NUN, INRAE, UMR 1280, PhAN, F-44000 Université de Nantes, France
| | - Guillaume Legendre
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Raoul Desbriere
- Department of Obstetrics and Gynecology, Hôpital Saint Joseph, Marseille, France
| | - Aude Girault
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, F-75014, Paris, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE,F-75004, Paris, France
| | - Jordan Pozzi
- CHU Brest, Hôpital Morvan, service de gynécologie-obstétrique, Brest, France
| | - Bertrand Gachon
- Department of Obstetrics and Gynaecology, La Milétrie University Hospital, Poitiers France; Nantes University, Movement - Interactions - Performance, MIP, EA 4334, F-44000 Nantes, France; INSERM CIC-P 1402, La Milétrie University Hospital, Poitiers, France
| | - Thiphaine Barjat
- Service de Gynécologie Obstétrique, CHU de Saint Etienne, Saint Etienne, France
| | - Franck Perrotin
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Université de Tours, Tours, France
| | - Solène Brunet-Houdard
- Tours University Hospital - Health-Economic Evaluation Unit, CHRU de Tours, Tours Area, France
- University of Tours - EA 7505-Education Ethics Health, Tours Area, France
| | - Caroline Diguisto
- Maternité Olympe de Gouges, Centre Hospitalier Régional Universitaire Tours, Université de Tours, Tours, France
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE,F-75004, Paris, France
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Mitchell JM, Dicker P, Madigan G, Nicholson S, Smyth S, Breathnach FM. Term induction of labour in nulliparous women: When to draw the line? Eur J Obstet Gynecol Reprod Biol X 2022; 15:100148. [PMID: 35517716 PMCID: PMC9062658 DOI: 10.1016/j.eurox.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 04/09/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
Objective Study design Results Conclusion
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Shahabuddin Y, Murphy DJ. Cervical ripening and labour induction: A critical review of the available methods. Best Pract Res Clin Obstet Gynaecol 2021; 79:3-17. [PMID: 34893438 DOI: 10.1016/j.bpobgyn.2021.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 01/18/2023]
Abstract
Induction of labour is one of the most common interventions experienced by pregnant women. There are two overlapping components to labour induction, which include cervical ripening and the initiation of regular contractions. A large number of clinical studies have been conducted for evaluating the methods used for induction of labour, their effectiveness and safety, and pregnancy outcomes. Randomised controlled trials (RCTs) provide the strongest form of evidence for clinical practice. These data are brought together in systematic reviews and have been incorporated into national and international guidelines. Despite this, there is considerable variation in the recommendations between guidelines. Heterogeneity between studies, inconsistency in the definitions of trial outcomes, and underpowered sample size contribute to the difficulty in making robust recommendations. There are pharmacological and non-pharmacological approaches that can be compared with each other and with placebo or no treatment. There are also complementary therapies that may appeal to women but lack evidence of their effectiveness. These issues have been addressed in the current chapter, with a critical review of the research evidence presented in clinical trials and systematic reviews.
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Affiliation(s)
- Yulia Shahabuddin
- Trinity College, University of Dublin, Ireland; Coombe Women & Infants University Hospital, Dublin, Ireland
| | - Deirdre J Murphy
- Trinity College, University of Dublin, Ireland; Coombe Women & Infants University Hospital, Dublin, Ireland.
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Sarno L, Tesauro M, Carlea A, Quaglia F, Maruotti GM, Pannella G, Trezza G, Guida M. Single versus double application of vaginal dinoprostone: maternal factors affecting responsiveness. J Matern Fetal Neonatal Med 2021; 35:4763-4767. [PMID: 33517810 DOI: 10.1080/14767058.2020.1863367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: The aim of our study was to identify maternal characteristics of women who are responsive to the second application of vaginal dinoprostone in a cohort of patients with a low Bishop Score. Secondarily, we compared the outcome of the patients' response to a single application to that of the women's response to a double application. Materials and methods: This was a retrospective observational cohort study. Patients undergoing preinduction of labor with dinoprostone 10mg controlled-release vaginal device were included. Results: Among 216 included patients, 192 women (88.9%) achieved a cervical ripening after a single application of dinoprostone, while 24 (11.1%) required a second application. Patients notresponding to the first application of dinoprostone had a significantly higher body mass index (27.4 ± 6.7 kg/m2 vs 24.9 ± 5.2 kg/m2; p < 0.05) and a significant increase in gestational weight gain (14 ± 5.2 kg vs 11.6 ± 6.1; p < 0.005). Double application of dinoprostone resulted in spontaneousdelivery in 58.4% of cases, but it was related to poorer neonatal outcome, compared to a single application. Conclusions: Obese women, not responding to the first application of dinoprostone could respond to the second application of this vaginal prostaglandin. However, data related to the use of a double application are still very limited to recommend its use as a standardized procedurefor not responsive patients.
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Affiliation(s)
- Laura Sarno
- Department of Neurosciences, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marina Tesauro
- Obstetrics & Gynecology Unit, San Pio Hospital, Benevento, Italy
| | - Annunziata Carlea
- Department of Neurosciences, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Filomena Quaglia
- Obstetrics & Gynecology Unit, San Pio Hospital, Benevento, Italy
| | - Giuseppe Maria Maruotti
- Department of Neurosciences, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | | | - Gennaro Trezza
- Obstetrics & Gynecology Unit, San Pio Hospital, Benevento, Italy
| | - Maurizio Guida
- Department of Neurosciences, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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